Knowledge Synthesis Methods Research Articles

The spectrum of knowledge synthesis methods: From big picture overview to targeted deep dive

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A Framework for a New Paradigm of Opioid Drug Tapering Using Adjunct Drugs.

The misuse of and dependency on prescription opioids represents a significant crisis at the national level, impacting not only the health of the public but also the societal and economic well-being. There is a critical need for strategies to reduce the dosage of prescribed opioids to limit opioid-associated adverse effects and lower the risk of addiction development in patients experiencing chronic pain. Opioid-sparing medications, when co-administered with opioids, enable a reduced opioid dose without loss of efficacy. This suggests the potential for using opioid adjunct drugs in opioid tapering, whereby opioid doses are lowered incrementally in a systematic manner to improve a patient's safety profile or quality of life. The objective of this report is two-fold: 1) to illustrate the potential for adjunct drugs in opioid tapering, and 2) to describe the steps needed to be taken to develop a framework for the use of adjunct drugs in opioid tapering. This can provide the impetus for further investigation into opioid tapering and the development of improved clinical care. The proposed project implements knowledge synthesis methods to develop the framework for a new paradigm of opioid drug tapering that incorporates opioid dosage reductions with adjunct drugs. Framework development is organized into three major phases: 1) Adjunct drug characterization, 2) Assessment of the opioid-sparing effect, and 3) Usability of data for clinicians. The knowledge gained from this project can provide a foundation for improved analgesia protocols for opioids and adjunctive drug therapy.

Bibliometric and content analysis of ChatGPT research in nursing education: The rabbit hole in nursing education

AimThis study was conducted to perform the bibliometric and content analysis of ChatGPT studies in nursing education. BackgroundChatGPT is an artificial intelligence-based chatbot developed by OpenAI. The benefits and limitations of the use of ChatGPT in nursing education are still discussed; however, it is a tool having potential to be used in nursing education. DesignBibliometric and content analysis. MethodsThe study data were scanned through Scopus and Web of Science. Bibliometric analysis was carried out with VOSViewer and Bibliometrix software. In the bibliometric analysis, science mapping and performance analysis techniques were used. Various bibliometric data, including most cited publications, journals and countries, were analyzed and visualized. The synthetic knowledge synthesis method was used in content analysis. ResultsWe analyzed 53 publications to which 151 authors contributed. The publications had been published in 29 different journals. The average number of citations of publications is 8.2. It was determined that most of the articles were published in Nurse Education Today and Nurse Educator journals and that the leading countries were the USA and Canada. It was observed that international cooperation on the issue was weak. The most frequently mentioned keywords in the publications were "ChatGPT", "artificial intelligence" and "nursing". The following three themes emerged after the content analysis: (1) Integration of ChatGPT into nursing education; (2) Potential benefits and limitations of ChatGPT; and (3) Stepping down the rabbit hole. ConclusionsWe expect that the results of the study can give nursing faculties and academics ideas about the current status of ChatGPT in nursing education and enable them to make inferences for the future.

Teaching Knowledge Synthesis Methods through Online Research Consultations

Requests to meet with academic librarians for support on knowledge synthesis (KS) projects have escalated due to an increasing number of learners embarking on KS projects as part of their course work, along with the recommendation in KS methods guidance to consult with a research librarian to ensure a comprehensive search. While there are program descriptions and evaluations of library-led and other KS methods training for groups or self-directed learning opportunities, little evidence examines the teaching practices of academic librarians in individual KS research consultations. The objective of this research is to explore teaching encounters during online KS research consultations and describe the often invisible aspects of that labour through the findings from an online-mediated, focussed ethnographic study. The study draws on data from focus groups, observations and interviews, as well as autoethnographic sources. We use a sociomaterial lens to analyze the stories in the data and illuminate the complexities of the virtual, synchronous teaching encounter between academic health librarians and learners. We present a composite narrative elaborating on the social, technical, and material elements assembled before, during, and after an online KS methods consultation to emphasize the invisible and affective labour of librarian teaching practices about comprehensive searching and KS methods.

Task force of the Brazilian Society of Otology — evaluation and management of peripheral facial palsy

ObjectiveTo review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. MethodsTask force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. ResultsThe topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. ConclusionsPeripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

The web-based “Right Review” tool asks reviewers simple questions to suggest methods from 41 knowledge synthesis methods

ObjectivesTo develop a web-based decision support tool that guides users through a series of simple questions for recommending knowledge synthesis methods suitable for their research question. Study Design and SettingWe used findings from previous work to structure a set of questions along key dimensions of different knowledge synthesis methods. We developed the tool using four steps: (1) designing the tool, (2) conducting usability testing, (3) disseminating the tool, and (4) evaluating its real-world use. Steps 1-3 were conducted iteratively, and the tool was evaluated using the RE-AIM framework. ResultsThe “Right Review” tool separates quantitative reviews and qualitative evidence synthesis (QES). Five questions are asked to select from among 26 methods for quantitative reviews, and 10 questions to select methods from among 15 QES. Conduct/reporting guidance and open-access examples are provided for each recommended method. The tool was disseminated to >4,600 users worldwide within 12 months. Evaluation results showed that the tool was fit-for-purpose and easy to use. ConclusionThe proliferation of knowledge synthesis methods makes it challenging for reviewers to select the “right” method. “Right Review” is a free, practical decision support tool that helps reviewers choose an appropriate method from 41 alternatives.

Adapting systematic scoping study methods to identify cancer-specific physical activity opportunities in Ontario, Canada

BackgroundIdentifying cancer-specific physical activity programs and post-secondary courses targeting students in academic settings (i.e., “real world” opportunities) may promote physical activity behaviors among cancer survivors. Using knowledge synthesis methods such as systematic scoping study methods may facilitate knowledge tool development and guide evidence-based practice to improve knowledge transfer. However, identifying these opportunities poses a challenge as systematic scoping study methods have yet to be applied and adapted to this context. Thus, to extend systematic scoping study methods, the purpose of the current investigation is to describe the adaptation of systematic scoping study methods in the context of cancer-specific “real world” opportunities in Ontario, Canada.MethodsSystematic scoping study methods were adapted to develop a knowledge tool, which was a credible resource website for researchers, clinicians, and survivors. Three search strategies including Advanced Google Search, targeted website search, and consultations with experts were used to identify eligible (e.g., appropriate for cancer survivors, offered in the community) cancer-specific physical activity programs. Only the targeted website search was used to search post-secondary institutions because they are centralized onto one government website.ResultsFifty-eight programs and 10 post-secondary courses met the eligibility criteria. Relevant data from these opportunities were extracted, charted, synthesized, and uploaded onto the resource website. The most successful search strategy for cancer-specific physical activity programs was the targeted website search followed by Google Advanced Search and consultations with content experts.ConclusionsChallenges were experienced due to lack of standard reporting among opportunities, bias of potentially relevant records, and changing nature of resulting records. The current investigation demonstrated that systematic scoping study methods can be applied to cancer-specific physical activity programs and post-secondary courses in the context of cancer survivorship in Ontario yielding robust results. The method can be further adapted and updated in future knowledge syntheses in health-related contexts.Systematic review registrationThe systematic scoping review method protocol has not been registered.

An Exploration of Business Librarian Participation in Knowledge Synthesis Reviews

Systematic reviews and other forms of knowledge synthesis are increasingly common in the social sciences, including in business and management research. We surveyed academic business librarians to determine the extent of their involvement, in any capacity, in knowledge syntheses. Of 71 eligible responses, 30 percent were involved in supporting knowledge synthesis, while others expressed an awareness of and interest in knowledge synthesis methods and have participated in training opportunities to support these types of projects in the future. While still nascent, knowledge synthesis support by business librarians presents potential as a new service area providing opportunities for deep engagement with faculty research.

Scoping Reviews of the Microbiology Literature: Methods and Payoffs

A scoping review is an approach to evidence synthesis. Its purpose is to provide an overview of the available research evidence without producing a summary answer to a discrete research question. Scoping reviews can be useful for answering expansive questions and identifying information relevant to a given research topic. The utility of scoping reviews is also to inform a systematic review, a knowledge synthesis process that aims to collect, and analyze all evidence that answers a specific research question. Scoping reviews are broadly depicted in the literature; however, the use of scoping review analysis techniques to rigorously prepare a clinical microbiology evidence base for comparison of multicomponent quality improvement interventions has not been explored. Recently, a pilot approach was published, and that approach is summarized here. It combined knowledge synthesis methods to (i) provide a meta-analytic route forward for a systematic review and meta-analysis (SRMA) and (ii) inform the American Society for Microbiology's (ASM's) approach to the production of clinical practice guidelines (CPGs). Further, a generalizable approach for other SRMA investigators who are similarly challenged by an evidence base that involves complex interventions was modeled by an ASM team re-exploring the impact of rapid diagnostics. While the approach is generalized, it is not intended to be prescriptive. The approach may frame or inform further conversation within the clinical microbiology community of practice and anyone reading the ASM CPGs. This article details a fundamental challenge to addressing “intervention complexity” in the clinical microbiology evidence base in the early stages of the CPG process.

Teaching Knowledge Synthesis Methodologies in a Higher Education Setting: A Scoping Review of Face-to-Face Instructional Programs

Abstract Background – Knowledge synthesis (KS) reviews are increasingly being conducted and published. Librarians are frequently taking a role in training colleagues, faculty, graduate students, and others on aspects of knowledge syntheses methods. Objective – In order to inform the design of a workshop series, the authors undertook a scoping review to identify what and how knowledge synthesis methods are being taught in higher education settings, and to identify particularly challenging concepts or aspects of KS methods. Methods – The following databases were searched: MEDLINE, EMBASE & APA PsycInfo (via Ovid); LISA (via ProQuest); ERIC, Education Research Complete, Business Source Complete, Academic Search Complete, CINAHL, Library & Information Science Source, and SocIndex (via EBSCO); and Web of Science core collection. Comprehensive searches in each database were conducted on May 31, 2019 and updated on September 13, 2020. Relevant conferences and journals were hand searched, and forward and backward searching of the included articles was also done. Study selection was conducted by two independent reviews first by title/abstract and then using the full-text articles. Data extraction was completed by one individual and verified independently by a second individual. Discrepancies in study selection and data extraction were resolved by a third individual. Results – The authors identified 2,597 unique records, of which 48 full-text articles were evaluated for inclusion, leading to 17 included articles. 12 articles reported on credit courses and 5 articles focused on stand-alone workshops or workshop series. The courses/workshops were from a variety of disciplines, at institutions located in North America, Europe, New Zealand, and Africa. They were most often taught by faculty, followed by librarians, and sometimes involved teaching assistants. Conclusions – The instructional content and methods varied across the courses and workshops, as did the level of detail reported in the articles. Hands-on activities and active learning strategies were heavily encouraged by the authors. More research on the effectiveness of specific teaching strategies is needed in order to determine the optimal ways to teach KS methods.

Text mining to support abstract screening for knowledge syntheses: a semi-automated workflow

BackgroundCurrent text mining tools supporting abstract screening in systematic reviews are not widely used, in part because they lack sensitivity and precision. We set out to develop an accessible, semi-automated “workflow” to conduct abstract screening for systematic reviews and other knowledge synthesis methods.MethodsWe adopt widely recommended text-mining and machine-learning methods to (1) process title-abstracts into numerical training data; and (2) train a classification model to predict eligible abstracts. The predicted abstracts are screened by human reviewers for (“true”) eligibility, and the newly eligible abstracts are used to identify similar abstracts, using near-neighbor methods, which are also screened. These abstracts, as well as their eligibility results, are used to update the classification model, and the above steps are iterated until no new eligible abstracts are identified. The workflow was implemented in R and evaluated using a systematic review of insulin formulations for type-1 diabetes (14,314 abstracts) and a scoping review of knowledge-synthesis methods (17,200 abstracts). Workflow performance was evaluated against the recommended practice of screening abstracts by 2 reviewers, independently. Standard measures were examined: sensitivity (inclusion of all truly eligible abstracts), specificity (exclusion of all truly ineligible abstracts), precision (inclusion of all truly eligible abstracts among all abstracts screened as eligible), F1-score (harmonic average of sensitivity and precision), and accuracy (correctly predicted eligible or ineligible abstracts). Workload reduction was measured as the hours the workflow saved, given only a subset of abstracts needed human screening.ResultsWith respect to the systematic and scoping reviews respectively, the workflow attained 88%/89% sensitivity, 99%/99% specificity, 71%/72% precision, an F1-score of 79%/79%, 98%/97% accuracy, 63%/55% workload reduction, with 12%/11% fewer abstracts for full-text retrieval and screening, and 0%/1.5% missed studies in the completed reviews.ConclusionThe workflow was a sensitive, precise, and efficient alternative to the recommended practice of screening abstracts with 2 reviewers. All eligible studies were identified in the first case, while 6 studies (1.5%) were missed in the second that would likely not impact the review’s conclusions. We have described the workflow in language accessible to reviewers with limited exposure to natural language processing and machine learning, and have made the code available to reviewers.

Unbiased Approaches for Reviewing Entomology Literature: A Systematized Review

AbstractEvidence synthesis and knowledge translation are scientific methodological approaches used across different disciplines for combining results from individual studies, interpreting them based on the body of evidence and with the objective of supporting decision-making. Systematic, rapid, and scoping reviews have a direct application in human health and social care, but also in veterinary medicine, which are areas that can overlap with medical and veterinary entomology. As a scientific field, the objective of medical and veterinary entomology is to identify and quantify the role of insects as transmitters of important arthropod-borne pathogens, thus contributing to the study of human and veterinary issues of public health importance. The main objectives of this review are to introduce to entomologists the most common knowledge translation and synthesis methods described in the literature, to then review the use of systematic, rapid, and scoping reviews applied in the medical and veterinary entomology field, using a systematized review approach. We found 120 relevant articles in the literature addressing topics related to medical and veterinary entomology and using systematic reviews of the literature or other evidence synthesis methods, which is concurrent with the ongoing trend towards the use of these methodologies. The application of unbiased approaches to entomology in general, and to medical and veterinary entomology in particular, will strengthen science- and evidence-based conclusions to be used as a tool for informing policy, decisions, and interventions.

Characteristics of Indigenous healing strategies in Canada: a scoping review.

The objective of this review was to identify the characteristics of Indigenous healing strategies in Canada and culturally relevant approaches within Indigenous contexts. In responding to the Canadian Truth and Reconciliation Commission's Calls to Action, there is increasing interest in Indigenous healing strategies across clinical, policy, and community sectors. The high relevance of Indigenous healing has also encouraged exploration of new approaches to research that are responsive to, and inclusive of, Indigenous contexts. To date, there is no clear understanding of what characterizes Indigenous healing strategies in Canada. This review considered healing strategies for First Nations, Inuit, and Métis in Canada. Strategies examined included those related to health services and programs, policies and guidelines, models and frameworks, and Indigenous narratives and expert opinion in any service setting. This review employed the JBI approach to scoping reviews. Searches were performed in CINAHL Full Text, Sociological Abstracts, PsycINFO, MEDLINE, and Academic Search Premier in December 2018. Searches for gray literature were conducted in iPortal, Canadian Electronic Library, and a list of Canadian government and Indigenous organization websites in February 2019. This review was limited to publications from 2008 onward. Non-English articles and theses and dissertations were excluded. Among the 59 articles included in this review, 41 were journal articles and 28 were published within the previous five years (i.e., 2014 and onward). The healing strategies were most frequently implemented in Ontario (n = 13), British Columbia (n = 8), and Manitoba (n = 5). The majority of strategies were utilized in the health settings (n = 37), which included mainstream treatment modalities as well as community-based healing initiatives. Services and programs (n = 24) were the predominant type of healing strategies, followed by models and frameworks (n = 9), policies and guidelines (n = 8), Indigenous narratives and expert opinion (n = 7), and others (n = 11). The most frequent guiding principles were identified as Honoring Cultures and Traditions (n = 14), Medicine Wheel (n = 12), and Strength-Based/Empowerment (n = 12). The most widely used main components were Artistic Expression (n = 16), Ceremonies (n = 15), and Games and Exercises (n = 12). As for human resources, Community Members (n = 19) were most frequently engaged, followed by Local Agencies (n = 12) and Knowledge Keepers (n = 12). Eight culturally relevant approaches were identified from 29 primary research studies, with the most popular being Consultation/Participatory Research (n = 20) and Indigenous Protocols (n = 5). The findings of this review collectively support a decolonizing approach that upholds Indigenous knowledge, respects Indigenous rights to self-determination, and recognizes Indigenous resilience and agency. More research is needed with a focus on Inuit or Métis healing, and innovative knowledge synthesis methods inclusive of diverse Indigenous ways of knowing.

A CONCEPTUAL MODEL OF CREDIT SCORECARD IN PRODUCTIVE LOAN

This study is aimed to discuss variables involved in credit scorecard assessment for granting agricultural credits. To get the variables, authors approached with the synthesizing method or Knowledge Synthesis Method from 25 papers related to the credit scorecard development in SMEs and Agriculture. This study used 5 C’s of credit concept to group related variables and eliminated which are not. It is found that from the five aspects of 5C’s, the character aspect consists of management, relationship, credit history, good corporate governance (GCG), behavior, and innovation. The capacity aspect consists of liquidity, profitability ratio, indebtedness degree, repayment history, activity ratio, financial growth, and expense ratio. The capital aspect consists of one indicator, namely capital structure. The conditioning aspect comprises of external factors of PESTEL, industry, and scope of a region in terms of monitoring. The collateral aspect consists of one indicator, which is a guarantee. All of these indicators will be a basic determinant of variables to appraise credit risk quality of a borrower in the agriculture sector. The limitation of this study is the scope limitation of conducting literature synthesize in particular papers which are related to appraising borrowers who are proposing productive loan, particularly in SMEs and the agriculture sector. The finding of this study will be useful for financial institutions that are responsible for developing assessments for borrower candidates in SMEs or the agriculture sector. Further process of research is eligible to be conducted, either qualitative or quantitative, in order to validate and improve the findings in this paper.

Unsettling Knowledge Synthesis Methods Using Institutional Ethnography: Reflections on the Scoping Review as a Critical Knowledge Synthesis Tool.

Scoping reviews are an increasingly popular knowledge synthesis method. While knowledge synthesis methods abound in evidence-based practices, these methods are critiqued for their reliance on positivism. Drawing on a scoping review that mapped scholarly conceptualizations of family caregivers' information-related dementia care work, in this article, I reconcile institutional ethnography's epistemological and ontological assumptions with the prescribed scoping review framework. I first explore the textual organization of scoping reviews. I then unpack the process of modifying three scoping review stages in keeping with an institutional ethnography method of inquiry, and in doing so, transform the scoping review into a critical knowledge synthesis tool. Through a reflexive process, I deconstruct scoping review's textual authority and uncover that scoping reviews bring about a double decontextualization of family caregivers' information work, removing family caregivers from their experiences of their information-related care work while simultaneously reducing them to objects of techno-scientific interventions.

Breakthrough Knowledge Synthesis in the Age of Google

Epistemology is the main branch of philosophy that studies the nature of knowledge, but how is new knowledge created? In this perspective article, I introduce a novel method of knowledge discovery that synthesizes online findings from current and prior research. This web-based knowledge synthesis method is especially relevant in today’s information technology environment, where the research community has easy access to online interactive tools and an expansive selection of digitized peer-reviewed literature. Based on a grounded theory methodology, the innovative synthesis method presented here can be used to organize, analyze and combine concepts from an intermixed selection of quantitative and qualitative research, inferring an emerging theory or thesis of new knowledge. Novel relationships are formed when synthesizing causal theories—accordingly, this article reviews basic logical principles of associative relationships, mediators and causal pathways inferred in knowledge synthesis. I also provide specific examples from my own knowledge syntheses in the field of epidemiology. The application of this web-based knowledge synthesis method, and its unique potential to discover breakthrough knowledge, will be of interest to researchers in other areas, such as education, health, humanities, and the science, technology, engineering, and mathematics (STEM) fields.

A scoping review of knowledge syntheses in the field of evaluation across four decades of practice

This scoping review of 62 knowledge syntheses published in evaluation-focused journals between 1979 and May 2018 provides a portrait of synthesis practices and their evolution in the mainstream of the field of evaluation. Concerns surrounding the production of knowledge syntheses to answer policy questions are not new in the field of evaluation. However, during this last decade, knowledge synthesis methods have expanded as a means to go beyond the limits and constraints of singular evaluations. This scoping review reveals and discusses two key issues with regards to the expansion of knowledge synthesis practices within the field of evaluation: the diversity—and muddling— of methodological practices and synthesis designs, and the frequent omission of quality appraisals.

Public Health Impacts of Famine in the Horn of Africa

Background: In the Horn of Africa, the oral stories and written records show that famine has been periodically occurring in the region. In their daily prayers, when the Oromo elders say, give us peace, preclude us from extreme war, poverty, famine, and epidemic diseases, they are stating their longtime wishes and hopes. By that, on the one hand, they are acknowledging that famine is a longstanding public health problem, on the other, they are teaching the young generation the need to prevent war, poverty, famine, and diseases. In this paper, following the footstep of the blessing of Oromo elders, I want to synthesize knowledge and explore the intermingled relationships between famine, poverty, war, and diseases. Objectives: The primary objective of this paper is to explore the primary, secondary, and tertiary effects of famine on population health. Methods: Using knowledge synthesis methods, I conduct a systemic review, contextualize, and integrate different findings and interpret the results. Results: The public health impacts of famine are multifold. It is responsible for several infectious and chronic diseases, nutritional deficiency disorders, instability, environmental degradation, and poverty. Those problems manifest in the short term and long term, in the first generation, second and third generations. Conclusion: In the Horn of Africa, famine is a major public health problem. The people need to learn from the past and envision the need for transformative leadership and institutions that enable them to guarantee food security and improve public health conditions.

USE OF THE BIBLIOGRAPHIC REFERENCE MANAGER IN THE SELECTION OF PRIMARY STUDIES IN INTEGRATIVE REVIEWS

ABSTRACT Objective: present the use of the bibliographic reference manager EndNote( as a support tool in the construction of a database and the selection of primary studies to develop integrative reviews. Method: a reflection study was undertaken, based on the international and the Brazilian literature. Results: the elaboration of an integrative review permits summarizing the knowledge about the theme of interest delimited in the health area, which can contribute by providing recommendations based on research results for clinical practice, as well as by identifying knowledge gaps, driving future research development. The use of bibliographic reference management tools is important for the selection of primary studies, permitting the location of repeated references, identification of languages, selection of publication periods and the creation of citations in the elaboration of the scientific text, among other resources. Conclusion: the advance in technologies, particularly the software EndNote(, has provided resources for the practicability of knowledge synthesis methods, in a transparent and replicable manner, consequently entailing a better quality of this type of study.

Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum

Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research.
 We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.